Bulletin

28 | Bulletin vol. 34 no. 1 In a retrospective mixed methods study, we identified recurring themes in the art therapy products (N=370) including representations of the self within individual personhood, relationships, community, and society using visual imagery symbolizing injury, relational supports and losses, identity transitions and questions, cultural metaphors, existential reflections, and conflicted sense of self (Walker et al., 2017). This construct helps us to better identify what the SMs are most concerned about or focused on as they move through treatment, to better understand the nature of their injuries, and to identify what behavioral content the interdisciplinary team might want to focus on and process with the patient. We found strong associations between the artistic depiction of psychological injury and mental health issues such as PTSD, depression, and anxiety, as well as the depiction of military unit identity (Kaimal et al., 2018). Results suggest that art therapy may be used to uncover and help resolve difficult psychological issues faced by the SMs. We began to wonder if the visual representations in the art therapy would be directly associated with brain activity, specifically the Default Mode Network (DMN), which is a large scale brain network of interacting brain regions, and the thalamus which is responsible for sensory integration. Interestingly, we found that the depiction of psychological injury during art therapy was associated with abnormal DMN and thalamic activity (Walker et al., 2018). In art therapy practice, the art therapy products are always used by the clinician to determine treatment choices within the context of the therapeutic relationship, and the information we glean from these relationships as well as from the products provides rich material to the treatment team and significant contributions to interdisciplinary work. Additional key research findings, as well as an inventory of our mixed methods creative arts therapies studies and publications, can be found on the Creative Forces National Resource Center (https://www.creativeforcesnrc.arts.gov/our-impact/clinical- research-findings). All publications are open access. We seek to continue to build upon our current body of research and help to answer some of the complex questions regarding art therapy's and art-making's effects on the brain as well as the whole person. To this end, we have new, prospective studies on the horizon. A promising direction for research in the arts therapies is the use of mobile encephalography (EEG) and mobile brain- body imaging (MoBI) which allow for movement in real world environments while controlling for noise inherent in any EEG reading (King & Kaimal, 2019; King et al., 2017). The use of EEG to track brain wave activity provides rich data that contributes to a greater understanding of connectivity patterns, and when paired with fMRI neuroimaging, moves us towards an enhanced understanding of the correlations between artistic process and brain function (J. King, personal communication, May 12, 2020). Worth Parker (2020) wrote that the Marine "credits the mask as the catalyst for much that has come after. Making that mask, he says, was 'the key to it all.'" The story of the Marine goes far beyond his initial experience with art therapy. He went on to partake in a community glass-blowing workshop. Afterwards, he helped to create a glass-blowing initiative for fellow veterans. He and I have spoken about glass-blowing as an art form, and the elements of danger, fragility, team work and trust involved... all elements with which an SM is familiar after serving in a troop or team within the military – what many of them call their tribe. Photo credit: The National Intrepid Center of Excellence "Within," Cast glass, Neuroimaging scan Photo credit: The artist These same elements are creating the sense of community we have found is crucial to SMs' and veterans' well-being. Six years after treatment at the NICoE, the Marine volunteered to testify before Congress in support of the arts for military service members and veterans. In his testimony, the Marine asserted, "I can state unequivocally that art therapy has helped me to be a better human, husband, father, and friend. I can also state unequivocally that art therapy has helped save my life" (Stowe, 2019). While visiting his program "Art of Valor" last year, the Marine requested I bring a blank paper mache mask with me, the same kind he started his art therapy journey with back in 2013. He used the blank mask as a mold for hot glass casting, and out of this process came clear glass mask forms. He has now started to incorporate imagery and words behind the glass masks which are representational of what is going on inside his head, a series he's entitled "Within." One mask incorporates his very own brain images, which was slated to be exhibited at the Kennedy Center as part of a Creative Forces exhibit that was postponed indefinitely due to COVID-19. The exhibition is now planned to take place virtually on the Creative Forces National Resource Center in winter 2021. I like to think of the Marine's glass masks as a beautiful metaphor for the content covered in this article. Art therapy and art-making lead to transparency of the human condition and insights into the human mind. Insights that could help all providers engaged in the recovery of SMs and veterans with TBI and associated mental health conditions better understand their patients, formulate treatment trajectories, and help to integrate into the patients' lives what is needed to keep these SMs and veterans healthy post-treatment.

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